Provider Demographics
NPI:1831488766
Name:WEINERMAN PAIN AND WELLNESS, LLC
Entity Type:Organization
Organization Name:WEINERMAN PAIN AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-988-9503
Mailing Address - Street 1:100 S BROAD ST
Mailing Address - Street 2:SUITE 1800-B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110-1023
Mailing Address - Country:US
Mailing Address - Phone:215-988-9503
Mailing Address - Fax:215-988-9533
Practice Address - Street 1:100 S BROAD ST
Practice Address - Street 2:SUITE 1800-B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1023
Practice Address - Country:US
Practice Address - Phone:215-988-9503
Practice Address - Fax:215-988-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004236L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care